Neurologist

A neurologist is a medical doctor involved in the management of conditions affecting both the central nervous system (brain and spinal cord) and the peripheral nervous system

As a neurologist, you'll diagnose, treat and manage patients with a range of diseases, disorders and conditions affecting neurological function. These include:

• strokes
• multiple sclerosis
• headaches
• black outs
• Parkinson's disease
• Alzheimer's disease and other forms of dementia
• motor neuron disease
• epilepsy
• spinal cord diseases
• muscle diseases like muscular dystrophy
• infections affecting the nervous system
• brain tumours (where surgery is required, the patient will be referred to a neurosurgeon).

You'll work as part of a multidisciplinary team that includes other neurology specialists and other members of the healthcare team, including speech and language therapists, occupational therapists and doctors in rehabilitation medicine.

Responsibilities

As a neurologist, you'll need to:

• diagnose complex neurological problems by listening to the patient's history, as well as by examining them and using appropriate neurological tests
• run outpatient clinics, where you'll mainly see patients with a chronic condition, i.e. a disease that takes a long time to develop such as Parkinson's and multiple sclerosis, or diagnose rare diseases
• complete ward rounds where you'll look after a caseload of inpatients
• treat acute conditions, i.e. those that come on suddenly, such as a stroke
• offer specialist expertise and guidance to other doctors and staff from a range of medical specialties
• spend approximately half a day a week in academic meetings with neurosurgeons, neuroradiologists and other neurological colleagues for learning and development and to discuss cases as a team, drawing on the expertise of all these specialists
• liaise with other medical and non-medical staff in hospital settings to ensure all of the patients' needs are met
• keep up your knowledge of the latest treatments for neurological disorders, which have increased significantly over recent years
• carry out teaching of junior staff, audits of practice and research.

Salary

• Junior doctors undertaking foundation training earn a basic salary of £28,808 to £33,345.
• As a doctor undertaking your specialist training, your basic salary ranges from £39,467 to £53,077.
• The basic salary for specialty doctors ranges from £45,124 to £77,519.
• Newly qualified consultants earn a basic salary of £84,559 rising to £114,003, depending on length of service.

As well as a basic salary, doctors in training earn extra for any hours over 40 per week, a 37% enhancement for working nights, a weekend allowance for any work at the weekend and an availability allowance if they are required to be available on-call.

Consultants may also apply for local and national Clinical Excellence Awards. They can also supplement their income by working in private practice.

Figures relate to the pay and conditions of medical doctors within the NHS, which is the largest employer of neurologists in the UK. Consultants working in the private sector can expect to be paid more.

Income data from Health Careers - Pay for doctors. Figures are intended as a guide only.

Working hours

A working week will typically be 40 hours, with hours generally between 8.30am and 5.30pm, five days a week. However, it's likely you'll have to work some nights, weekends or be on call (where you're available to be called for work, usually outside your normal working hours). Most trainees at foundation, core and higher level will be expected to work periods of being on call.

Part-time work is possible with opportunities for a good work/life balance. As a core and specialty trainee you'll usually be employed on short-term contracts of six to 12 months.

What to expect

• The role is varied and you'll work with inpatients on the ward, as well as running outpatient clinics.
• You'll encounter more chronic disease than you'll find in many specialties in medicine. This allows you to build a long, therapeutic relationship with some patients who you'll see over years.
• As a trainee, you'll spend some shifts in the emergency department treating patients that come in after having a stroke, or suffering with other neurological emergencies.
• You'll be treating illnesses that can affect the young, such as neuromuscular disorders, and those that affect the old, such as dementia.
• You may encounter some cases where patients have problems that are mainly psychological but still very disabling. These include types of fits, seizures or black outs that aren't epileptic in origin but related to complicated reactions to stress or traumas.

Qualifications

To become a neurologist, you'll need to start by taking a degree in medicine recognised by the General Medical Council (GMC). This usually takes five to six years to complete.

If you've already got a degree in a subject other than medicine (usually a 2:1 or above in a science-related subject) you can apply for a four-year accelerated graduate entry medicine programme (also known as a graduate entry programme). The British Medical Association has further information about applying to medical school as a graduate.

There are also 'foundation' or 'gateway' degrees available that add a preliminary year to your medical degree. These have been brought in to help widen access to medicine. For more information, see the Medical Schools Council (MSC).

You'll then go on to complete the two-year UK Foundation Programme, a paid training job in a clinical setting. During this time, you'll work in hospitals as a junior doctor on a rotational basis in different departments, that may include neurology. After the first year of training you'll be recommended for full registration as a doctor with the GMC. On successful completion of the foundation training, you're awarded the Foundation Programme Certificate of Completion (FPCC).

At this point, you must apply in open competition for the three-year Internal Medicine Training (IMT) programme via Oriel, the UK-wide portal and recruitment system for postgraduate specialty medical, dental and public health training. This is the first stage of specialty training and will provide you with the skills you need to lead on the care of patients in both acute care and general ward settings. For more information, see IMT recruitment.

In your third year of IMT, you must apply for specialty training, again in open competition via Oriel. Before starting specialty training, however, you must pass the Membership of the Royal College of Physicians (UK) Diploma (MRCP(UK) Diploma). For more information on the application process, see Medical and Dental Recruitment and Selection.

Specialty training in neurology currently consists of five years, one of which may be relevant research. From August 2022, however, a new curriculum for dual training in neurology and internal medicine is being introduced. Training will last five years and, as part of the training, you will dual train in internal medicine. The curriculum will also include stroke medicine as a sub-specialty. During this time you must also complete the MRCP(UK) Specialty Certificate Examination (SCE) in Neurology.

By the end of your postgraduate training you'll gain a Certificate of Completion of Training (CCT) in neurology and internal medicine with sub-specialty accreditation in stroke, which enables you to register on the GMC specialist register and apply for substantive consultant-level posts in neurology, internal medicine or stroke. (If you're training under the old curriculum, you will receive a CCT in neurology only.)

Details of transition arrangements in place for existing trainees are available from the Association of British Neurologists.

Skills

You'll need to have:

• knowledge of anatomy, physiology, the central nervous system and other body systems
• diagnostic skills to determine the type of disease or condition, its severity and extent
• practical skills, to be able to complete clinical neurological examinations
• the ability to communicate effectively, both verbally and in writing, with patients and staff from a range of backgrounds
• problem-solving and clinical decision-making skills
• the ability to work independently and as part of a team
• time management and organisational skills
• familiarity with research methods and a willingness to keep up to date with advances in treatments
• leadership ability
• professional integrity and honesty, respecting both patients and colleagues
• a flexible approach to work and the ability to consider all factors before reaching a decision
• commitment, drive and focus
• the ability to reflect and learn from your own work and a commitment to continuing professional development (CPD).

Work experience

Before applying to do a medical degree, you'll be expected to undertake work experience, either paid or voluntary, in areas relevant to medicine. This could be through work experience at your local hospital, nursing home or through work shadowing a doctor. This experience shows your commitment to becoming a doctor and provides insight into the physical and emotional demands of working in medicine.

Once you're a medical student you could consider becoming a student member of the:

• Association of British Neurologists (ABN)
• Royal College of Physicians

Membership provides access to a range of news, information and events, as well as networking opportunities.

You could also join a university neurology student society to keep informed about developments.

During your two-year foundation training as a junior doctor, try to get onto a neurology rotation. If that's not possible, you can talk to neurologists to arrange a neurology taster session. This will give you a good insight into the work.

Find out more about the different kinds of work experience and internships that are available.

Employers

The NHS is the largest employer of neurologists. There are also opportunities to work in the private sector.

Look for job vacancies at:

• ABN Jobs Board
• BMJ Careers
• NHS Jobs - England and Wales
• NHSScotland Jobs
• Northern Ireland Health and Social Care Jobs
• websites of private healthcare companies.

Individual trusts and hospitals may also advertise vacancies on their websites and sometimes in printed bulletins.

Professional development

Once qualified, you'll be expected to continue learning throughout your career. Continuing professional development (CPD) is essential if you want to remain on the GMC register. CPD activities can include attending courses, conferences, meetings and workshops, as well as undertaking research and peer-reviewing journal papers.

Although not essential, additional postgraduate qualifications can be useful and many neurologists choose to study for a PhD. If you decide to follow an academic research career, however, you must study for a PhD in an area of original research.

If you wish to integrate more formal teaching into your work, you could study for a qualification in medical education.

Career prospects

As a consultant you'll gradually gain more experience in your clinical duties and take on more responsibilities. You'll have the opportunity to move into managerial roles, initially as a medical lead (a lead consultant for a team), then as a clinical director (a lead consultant for a department) and later on as a medical director (a lead consultant for a hospital trust).

If you wish to take up scientific research and an academic career, you'll need to start early at medical school or during your Foundation Training as this field is highly competitive.

Neurologists interested in teaching future doctors may become a director of medical education, training programme director or associate dean in charge of the entire training programme.

There are also opportunities to work in the private sector or to set up your own practice.